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Peripheral neuropathy is considered the most common complication of diabetes and is thought to occur in 50% of diabetics over the age of sixty. This means that the complications of peripheral neuropathy are superimposed upon the changes (physical and emotional) that take place naturally in aging people. The presence of diabetic peripheral neuropathy is associated with:

• Increased morbidity
• Increased mortality
• Impaired quality of life

Diabetic patients experiencing peripheral neuropathy suffer from multiple problems related to the involvement of the lower extremities, including:

• Foot ulceration
• Postural instability
• Limited mobility
• Instability when walking or standing
• Gait changes, such as decreased walking speed and decreased stride length
• Reduced ankle joint movement
• Increased risk of falling and related injury such as fractures

Physical disability is related to a combination of sensory abnormalities (e.g. lack of sensation of injury which may lead to ulceration) and mechanical factors (reduced ankle movement and resulting instability, reduced muscle strength) due to the various types of fibers affected by the diabetes. In addition to the neuropathy-related changes, specialized shoes, braces, and orthoses that patients may use create such a different sensation of balance that patients reduce their customary amount of walking. This limits their independence and activities of daily living even further. In general, it is estimated that neuropathic patients with diabetes are 15 times more likely to report injury related to standing or walking than nondiabetics.

Studies have shown that diabetic patients with peripheral neuropathy who suffer from symptoms such as pain, unsteadiness, or reduced sensation and/or foot ulcers report problems with:

• Physical and emotional well-being
• Carrying out activities of daily living
• Changes in self-perception
• Interpersonal relationships
• Reduced independence
• Depression

In addition to vigilant glucose control, dietary changes, and exercise, intervention should focus on enhancing balance and mobility so that patients can maintain their independence and improve their quality of life. Patients may need additional rehabilitation (such as physical or occupational therapy, or being fitted with braces or orthoses) as well as psychological or emotional counseling in order to treat any coexisting depression.